CareFlight treatment is substandard, claim doctors

EMERGENCY medicine doctors have claimed the ambulance-helicopter charity CareFlight is providing substandard care to patients and operating with little oversight.

In a letter obtained by Fairfax Media, the medical manager of the Greater Sydney Emergency Medical Helicopter Service and 19 doctors from major Sydney hospitals said they have "serious concerns" about the care provided by CareFlight.

Fairfax Media understands the relationship between clinicians from the Ambulance Service of NSW and CareFlight has long been strained, but the letter represents an unprecedented escalation of the tensions.

A number of treatments provided by CareFlight have not met "expected standards of critical care," the doctors say, in a letter addressed to the director general of NSW Health, Mary Foley and written on ambulance service letterhead.

It says CareFlight has inappropriately prioritised scene times over patient treatment priorities, "leading to the transport of unstable patients from scene with inadequate resuscitation".

Other problems listed include "inadequate assessment of patients, failure to apply minimum mandated monitoring standards, particularly with regard to airway management, and inconsistent levels of intervention based on individual physician preference".

The letter also accuses CareFlight of failing to meet established standards of clinical care, of not being run transparently, and of only providing non-clinical performance data instead of the clinical performance data provided by all other services.

But a spokesman for the Ambulance service said the letter did not represent its views.

"The Ambulance Service of NSW has complete confidence in CareFlight and its staff who work across our medical retrieval system," he said.

The ambulance doctors' letter also expresses concerns that a trial run by CareFlight, called the HIRT trial, will be used to change clinical practice in NSW.

Insiders say the trial, which aimed to improve the results of head injury patients by quickly getting emergency trauma doctors to them, was not supported by some clinicians in the ambulance service.

According to the CareFlight annual report, the trial resulted in a 14 per cent absolute improvement in patient results and if implemented state-wide would save $1 million a week in reduced costs from trauma.

"We believe that, based on the evidence of the HIRT trial, there will be an ongoing role for our operation," the report says.

But the ambulance service doctors wrote in their letter they were concerned emergency treatment rules would be changed on the basis of the trial without any independent analysis of its results.

"We believe that important decisions about pre-hospital and retrieval service provision should be based only on robust evidence independently assessed and not unduly influenced by political interference or pressure by motivated lobby groups," the doctors wrote in their June letter.

The state opposition health spokesman, Andrew McDonald, said the health minister must ensure patient safety. "She needs to convince the people of NSW that the problem is being dealt with correctly," he said.

The Minister for Health, Jillian Skinner, said: "Achieving best possible patient outcomes motivates everything we do in health.''

CareFlight treated more than 5000 patients in the past financial year, its annual report shows. In the past two years it has more than doubled the number of patients it treats.